Provider Demographics
NPI:1194039156
Name:MODI, NEHAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NEHAL
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-2123
Mailing Address - Country:US
Mailing Address - Phone:609-581-5827
Mailing Address - Fax:609-581-7783
Practice Address - Street 1:622 RT 206 AND MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505
Practice Address - Country:US
Practice Address - Phone:609-298-8787
Practice Address - Fax:609-298-0421
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI027970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02797000OtherBOARD OF PHARMACY